There are many different types of birth control methods available in the United States. Below, is a brief discussion of the benefits and side effects of several popular forms of contraception. This is not intended to replace medical advice; ask your doctor what might be right for you.

‘The Pill’

One of the most popular forms of birth control is oral contraceptives, commonly referred to as ‘the Pill.’

The birth control pill is taken daily, and usually comes in packs containing 28 pills. They protect a woman from pregnancy seven days from the day she takes the first pill.

There are many varieties of this product, each with different levels and combinations of hormones, which means that a patient will probably be able to find one that works well for her. The Pill prevents pregnancy by releasing hormones that prevent the monthly release of an egg from the ovaries (ovulation), thus preventing fertilization. The Pill also forms a thick mucus barrier at the cervix–the entry to the uterus—which prevents sperm from entering the womb. If the first two scenarios fail, oral-contraceptive hormones also make the uterus slightly hostile to a fertilized egg, which prevents it from attaching to the uterine wall. With a success rate of over 99%, oral contraceptives correctly used are the most effective form of birth control available except for surgical sterilization.

The Pill also regulates menstrual periods, generally making them lighter and shorter, and in most patients dramatically reduces cramping pain.

Certain brands of the pill have also been used to improve facial complexions.

The Pill allows more spontaneous sexual encounters than condoms, but requires the user to remember to take it every day, preferably at the same time each day.

Patients may experience a small amount of weight gain. Serious side effects are rare, but can include an increased risk of heart problems, strokes, or blood clots, especially in smokers and in women over 35. With long-term use, there has been some evidence of a link to an increased risk in breast and cervical cancers, but the studies have been controversial and conflicting. (Conversely, the Pill is known to cut the risk of endometrial and ovarian cancers by half.) One important shortcoming is that the Pill does not guard against sexually transmitted diseases (STDs),including HIV/AIDS, so patients who use the Pill should also use condoms if they are not in a monogamous relationship.

Progestin-Only Pills (POPs)

Progestin-only pills are oral contraceptives taken daily that contain progestin, a synthetic version of the natural hormone progesterone, but no other hormones (conventional birth control pills use a combination of two hormones).

Progestin-only pills, or POPs, work by forming a thick mucus barrier across the cervix that prevents semen from entering the uterus. They also sometime, but not always, prevent the release of an egg from the ovary.

POPs are often used by breastfeeding mothers as a supplement to the natural pregnancy prevention that nursing provides. POPs, unlike combination-hormone pills, do not interact with a woman’s ability to produce milk for her baby.

The benefits and side effects of progestin-only pills are the same as for combination oral contraceptives. The failure rate, however, is somewhat higher (about 8% of women will become pregnant within a year with typical use of POPs), but perfect use can reduce the failure rate to about 1%.

POPs must be taken at the same time each day to maximize protection. Like oral contraceptives, progestin-only pills do not prevent STDs or HIV/AIDS.

The Patch

A slight variation of the Pill, the Ortho-Evra or ‘the Patch’ is a newcomer to the birth control market. It contains the same two hormones used in the vast majority of oral contraceptives—estrogen and progesterone—but delivers them via a patch that can be attached to the shoulder, buttocks, or hip.

The side effects of the Patch are the same the same as the Pill, with the addition of possible skin irritation at the patch site.

The major benefit of the Patch vis-à-vis the Pill is that the patient needs to change it only once a week, compared to the daily requirement of the Pill.

Ortho-Evra is the only birth control patch approved for sale in the United States, so until a generic version is available, the monthly cost of the Patch is often higher than the cost of the Pill.

Patients should be aware that, like the Pill, a barrier method (like condoms) should be used in addition to the Patch to protect against STDs.

Depo-Provera

Depo Provera is a hormone injection, usually in the arm or rear, which prevents pregnancy for 3 months. It utilizes progesterone to prevent ovulation, but because it does not contain estrogen, most women stop menstruating with use of Depo Provera.

Women who continue to have periods may find them irregular or heavy. Depo Provera offers the same level of protection from pregnancy as the Pill and other hormone methods, but the patient need not remember to take it daily or weekly. A doctor’s visit every 3 months is all that’s required.

The effectiveness, benefits, and side effects of Depo Provera are similar to those of the Pill, with one major exception: a study in 2004 showed that women who take Depo Provera lose bone density and are at a higher risk of osteoporosis later in life. It is not recommended as a long-term method of birth control or for women who are still growing.

One benefit of Depo Provera is that women become protected from pregnancy within 24 hours of receiving the injection, and it is approved for use by women who are 6 weeks postpartum. Like the Pill, Depo Provera does not protect against STDs, including HIV/AIDS.

The IUD

Despite a reputation for being dangerous, the Intrauterine Device (IUD) is a viable birth control method that is available in two forms: the drugs Paragard and Mirena.

Generally speaking, an IUD is a t-shaped piece of plastic or metal that is inserted into the uterus by a doctor, usually during a woman’s menstrual cycle, while her cervix is open. A small string extends down into the vagina. Once inserted, an IUD may remain in place for 5 to 10 years, providing extremely effective pregnancy prevention. Next to combination-hormone oral contraceptives, the IUD is the most effective form of birth control. It works by creating a hostile environment, preventing fertilized eggs from implanting in the walls of the uterus. Instead, the fertilized egg is expelled during the woman’s next menstrual cycle.

Mirena also makes use of levonorgestrel, a hormone also found in oral contraceptives. A benefit of the IUD is its convenience; once inserted, it requires no attention for years. Though the initial cost of the device is higher than most other forms of contraception, it is generally a lower-cost option in the long run.

The IUD was removed from the market in 1979, but current IUD options are considered safe and effective. Unlike oral contraceptives, there is no increased risk for IUD patients who smoke or have high blood pressure, and it can be used safely by breastfeeding women or women who are recently postpartum or postabortion.

There is some evidence that an IUD can guard against endometrial cancer.

Risks are rare but can be serious. First, the IUD may be expelled by the body. This usually happens within the first few months of use and is not harmful to the patient. The IUD cannot travel to other parts of the body and will exit via the vagina, leaving the patient unharmed but vulnerable to unplanned pregnancy. The most serious side effect is perforation (if the device penetrates the wall of the uterus). This usually happens during insertion and is very rare but may require surgery to repair damage. The most common side effects are cramping, spotting, and heavy or irregular periods, which tend to subside after a few months of use.

Diaphragms, Caps, and Shields

Diaphragms, caps, and shields are all barrier methods that prevent sperm from reaching the uterus. Each method consists of a latex or silicone dome which fits into the vagina, covering the cervix. Diaphragms are shallow domes which fit snugly into the top of the vagina, while caps and shields are narrower and fit snugly over the cervix itself.

All three of these devices require the use of spermicidal cream or jelly to maximize protection, and each requires a pelvic exam at a physician’s office or clinic in order to find the right fit.

Diaphragms, caps, and shields can be used within months of childbirth or abortion, and are safe to use while breastfeeding. They can also be easily carried in a purse or a pocket, and usually neither partner can feel it be felt during intercourse. Spontaneity of intercourse is achievable since a woman can insert her device hours ahead of time.

Also, these methods are immediately reversible should a woman decides to become pregnant, and do not interfere with her natural hormonal cycles. However, women with frequent urinary tract infections or a history of toxic shock syndrome and those allergic to latex or silicone should not use diaphragms, caps, or shields.

The failure rate with typical use is about 16%, and about 6% with perfect use. The higher failure rate occurs because some sexual positions or angles may dislodge the device, allowing semen to enter the uterus. An important consideration is that these barrier methods do not prevent sexually transmitted diseases, including HIV/AIDS.

Condoms

A non-invasive birth control alternative is the condom, a sheath usually made of latex that fits either over the penis or inside the vagina. Condoms collect semen and prevent sperm from entering a woman’s vagina, preventing fertilization. Condoms are touted as the best form of contraception to protect users from sexually transmitted diseases, including HIV, the virus that causes AIDS.

Condoms are available dry or with a lubrication that may include a spermicide for added protection. With perfect use, condoms provide a 98% success rate in preventing pregnancy, but typical use generally garners a rate of about 85%. This means that 15 out of 100 women who use condoms will become pregnant during the first year. When used in conjunction with spermicidal creams or jellies, or with a sponge, the prevention rate increases. It should be noted that frequent use of the spermicide nonoxynol-9, a common lubrication chemical, can irritate tissue and lead to a higher risk of contracting an STD, including HIV.

Condoms may be purchased over the counter in any grocery store or convenience store and are an inexpensive birth control method.

Some men report a dulling in sensation and dislike interrupting the sexual encounter to put on a condom, but many couples report feeling more comfortable during sex and foreplay because the worry of pregnancy and disease is diminished. There are no side effects with condoms, except in individuals who are allergic to latex—generally 1-2% of the population.

Withdrawal

Withdrawal occurs when a man removes his penis from the vagina before ejaculating, thus preventing sperm from entering the vagina. Withdrawal alone has a relatively high failure rate; roughly 27 women out of 100 will become pregnant within a year of typical use. Perfect use yields a failure rate of about 4%.

The benefit of withdrawal is that it can be used when no other method is readily available. One major drawback is that pre-ejaculate, which occurs during intercourse, contains enough sperm to cause pregnancy, and often occurs without the knowledge of either partner. Withdrawal has no side effects, but requires a great deal of self-control and trust for success. It is not recommended for men who ejaculate prematurely or are sexually inexperienced. Withdrawal does not protect either partner from STDs, including HIV/AIDS.

Natural Family Planning

For women who cannot tolerate oral contraceptives, or for couples whose religion discourages the use of traditional birth control, natural family planning is an alternative.

Natural family planning, also called periodic abstinence, requires a woman to chart her fertile days based on vaginal secretions. It is not the same as the rhythm method, in which couples abstain from sexual intercourse from days 9 through 14 of the woman’s cycle, but is based on secretions that can teach a woman about her own specific ovulation period.

Natural family planning has no side effects, but its effectiveness depends largely on being properly trained in recognizing fertile times. Since the Catholic Church advocates natural family planning, it is relatively easy to find helpful, free workshops about the method. The failure rate can vary widely, from 2% to 30%, depending on how diligent and knowledgeable the woman is about checking her mucus each day. With proper training and persistence, natural family planning can be extremely effective. It costs nothing and does not require a woman to alter her cycles with artificial hormones.

The disadvantages include a potentially high failure rate and a lack of spontaneity; couples may only have sex on non-fertile days, and must abstain on days where fertility is on an upswing. Also, natural family planning does not protect against STDs, including HIV, and is best suited to responsible couples in monogamous relationships.

Emergency Contraception

Emergency contraception is used in the hours and days following failure of a contraceptive method or after unprotected sex and is available in two forms: the Emergency Contraception IUD (EC IUD) and Emergency Contraception pills.

A woman who chooses the EC IUD will need to make a visit to a physician or clinic within seven days of unprotected intercourse.

The failure rate for this method is less than one in a thousand, but it will not work if a woman is already pregnant.

Emergency contraception pills must be taken within 72 hours of sexual intercourse to be effective, and generally have a failure rate of about 1 or 2 out of 100.

Common side effects include nausea and cramping. EC pill emergency take-home kits are often available from clinics for future use.

Emergency contraception relies entirely on getting to the doctor or clinic in time, and being sure that the patient is not already pregnant from previous sexual intercourse.

Abortion

Abortion, the surgical or medical removal of a fetus from the uterus, has been legal in the United States since 1972. The laws in each state vary, but generally speaking, a woman over the age of 18 (or under 18 with parental notification and consent) may seek an abortion in the first or second trimesters of her pregnancy.

Many abortions are performed surgically in outpatient clinics, under local or general anesthesia. Common side effects are abdominal pain, spotting and bleeding, nausea and vomiting, and diarrhea. More serious side effects include hemorrhage, perforation of the uterus and problems getting pregnant in the future, as well as other risks generally associated with surgery.

Some evidence has indicated an increase in the risk of breast cancer, but the evidence is not conclusive.

Medical abortions utilize two different medications, usually Mifepristone and misoprostol, to terminate the pregnancy. Mifepristone softens the cervix and causes the placenta to detach from the uterine wall, while misoprostol (usually administered the following day) causes uterine contractions, which expel the fetal material. Women are often allowed the option of either remaining in the clinic for the duration of the process or going home.

Medical abortions usually require 3 doctor visits, and are about 95-99% effective. Medical abortions performed early in the pregnancy have a greater success rate than those done later on. In the event that a medical abortion fails, a surgical abortion will be done to remove any remaining tissue.

Side effects of a medical abortion include cramping, nausea, diarrhea, and vaginal bleeding, as well as potential emotional side effects. Women who experience extremely heavy bleeding or a fever above 100.4 degrees after either type of abortion should seek medical attention immediately.

A Final Thought

Please remember that this information is offered purely for educational purposes, and that any decisions you make regarding contraception should be shared with your physician.